ART Monitoring and ADR Substitution
Which ART drug caused it, and the single-drug substitution that follows · v1.7- Enter the current regimen, then the adverse reaction you have identified from the list.
- Add the current creatinine clearance, the haemoglobin and the hepatitis B status.
- You get the drug most likely responsible, named, and the single substitution for it.
- Only the offending drug changes, because switching the whole regimen answers virological failure and that is a separate module.
- The scheduled monitoring for each regimen sits on the Monitoring Schedule tab.
- Reactions to any drug outside the ART regimen, cotrimoxazole and the anti-tuberculosis drugs included.
- Deciding whether an adverse reaction is present. It takes your identification from the list and works forward from it.
- Regimens other than the six first-line combinations listed, including any protease inhibitor based second-line regimen.
- Virological failure and the switch to second line, which the Virological Failure pathway decides.
1. Current Regimen
2. Identified Adverse Drug Reaction
3. Relevant Parameters
NACO Monitoring Schedule by Regimen
1. ADR Recognition Quick Reference
| Investigation | TDF-based | AZT-based | All Regimens |
|---|---|---|---|
| Serum Creatinine / CrCl | Baseline, 3 months, then 6-monthly | Baseline | As indicated |
| CBC with Differential | Baseline | Baseline, 4 weeks, 3 months, then 6-monthly | As indicated |
| HIV Viral Load | 6 months, 12 months, then annually | 6 months, 12 months, then annually | Primary measure of treatment success |
| CD4 Count | Baseline, 6 months | Baseline, 6 months | Stop routine CD4 testing once the count is stable at 350 or above on two occasions, on suppressive ART |
| ALT / AST | Baseline, as indicated | Baseline, as indicated | More frequent if NVP-based or HBV coinfection |
| Fasting Glucose / Lipids | Baseline, annually | Baseline, annually | DTG: monitor for metabolic syndrome |
| Urine Dipstick | Baseline, 6-monthly (glycosuria, proteinuria) | Baseline | Screen for TDF tubular toxicity |
| Pregnancy Test | As indicated | As indicated | All women of childbearing age at each visit |
| Drug | Key ADR | Time to Onset | Action |
|---|---|---|---|
| TDF | Nephrotoxicity, Fanconi syndrome | 3 to 12 months | Switch TDF to AZT or ABC |
| AZT | Anaemia, neutropenia | 4 to 12 weeks | Switch AZT to TDF or ABC |
| AZT | Myopathy, lipoatrophy | 6 to 18 months | Switch AZT to TDF |
| ABC | Hypersensitivity Reaction | First 6 weeks | Stop immediately. Never rechallenge. |
| DTG | Neuropsychiatric, weight gain | Weeks to months | Switch to EFV (if tolerated) or ATV/r |
| EFV | CNS toxicity, gynaecomastia | First 2 to 4 weeks | Switch EFV to DTG |
| NVP | Hepatotoxicity, SJS | First 6 to 18 weeks | Stop immediately. Switch to DTG. |
Abbreviations: ABC (Abacavir) · ADR (Adverse Drug Reaction) · ALT (Alanine Aminotransferase) · ANC (Absolute Neutrophil Count) · ART (Antiretroviral Therapy) · AST (Aspartate Aminotransferase) · ATV/r (Atazanavir/Ritonavir) · AZT (Zidovudine) · BD (Twice Daily) · CBC (Complete Blood Count) · CD4 (Cluster of Differentiation 4) · CNS (Central Nervous System) · CPK (Creatine Phosphokinase) · CrCl (Creatinine Clearance) · DTG (Dolutegravir) · EFV (Efavirenz) · FDC (Fixed-Dose Combination) · GI (Gastrointestinal) · Hb (Haemoglobin) · HbA1c (Glycated Haemoglobin) · HBV (Hepatitis B Virus) · HIV (Human Immunodeficiency Virus) · HLA-B*5701 (Human Leucocyte Antigen B, Allele 5701) · HSR (Hypersensitivity Reaction) · IRIS (Immune Reconstitution Inflammatory Syndrome) · LFT (Liver Function Test) · MI (Myocardial Infarction) · NACO (National AIDS Control Organisation) · NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor) · NVP (Nevirapine) · OD (Once Daily) · OI (Opportunistic Infection) · SBAR (Situation, Background, Assessment, Recommendation) · SJS (Stevens-Johnson Syndrome) · TAF (Tenofovir Alafenamide) · TDF (Tenofovir Disoproxil Fumarate) · TLd (Tenofovir + Lamivudine + Dolutegravir) · TLE (Tenofovir + Lamivudine + Efavirenz) · ULN (Upper Limit of Normal) · VL (Viral Load) · 3TC (Lamivudine)
References
- NACO. National Guidelines for HIV Care and Treatment. MoHFW, GoI; 2021.
- NACO. National Technical Guidelines on ART. 2018 (Updated 2021).
- WHO. Consolidated guidelines on HIV. 2021.
- World Health Organization. WHO updated recommendations on HIV clinical management: recommendations for a public health approach. Geneva: WHO; 7 January 2026. [First substantial revision since 2021.
How to Cite This Tool
DOIhttps://doi.org/10.5281/zenodo.22401592
AMA Style:Umakanth S. ART Monitoring and ADR Substitution. Version 1.7. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/hiv-monitoring-adr. doi:10.5281/zenodo.22401592
Vancouver Style:Umakanth S. ART Monitoring and ADR Substitution [Internet]. Version 1.7. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/hiv-monitoring-adr. doi:10.5281/zenodo.22401592
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Category Therapeutic & Management PathwaysGuide
Specialties Internal Medicine, Infectious Diseases, HIV Medicine